Healthcare Provider Details

I. General information

NPI: 1376686402
Provider Name (Legal Business Name): COOK'S HOME HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HILLSIDE AVE
PLYMOUTH CT
06782-2305
US

IV. Provider business mailing address

81 HILLSIDE AVE
PLYMOUTH CT
06782-2305
US

V. Phone/Fax

Practice location:
  • Phone: 860-283-4424
  • Fax: 860-283-6667
Mailing address:
  • Phone: 860-283-4424
  • Fax: 860-283-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN A. MACDONALD
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 860-283-4424